The experience of workflow optimization of the city polyclinic based on the principles of lean production and IT-based management

Введение. Внедрение бережливого производства в медицинских организациях обуслов лено реализацией национального проекта «Здравоохранение». В связи с этим актуализируется вопрос подготовки медицинских кадров, владеющих бережливыми технологиями. Для достижения данной цели образовательные организации не только включают в учебные планы дисциплины, раскрывающие философию, принципы и инструменты бережливого производства, но и вовлекают студентов и ординаторов в проектную деятельность. Цель исследования-проанализировать факторы, формирующие движущие силы и силы сопротивления у студентов по отношению к проектной деятельности в рамках реализации концепции «Бережливый вуз». Методы. Исследование построено на основе использования метода анализа силового поля, интегрированного в трехэтапную теорию изменения Курта Левина. Исследовательскую выборку составили студенты федерального государственного бюджетного образовательного учреждения высшего образования «Кубанский государственный медицинский университет» Министерства здравоохранения Российской Федерации. С помощью анонимного анкетирования студентов, разделенных на две целевые группы (не вовлеченных в реализацию проекта «Бережливый вуз» и имеющих опыт проектной деятельности), были выявлены основные факторы, формирующие движущие силы и силы сопротивления у студентов по отношению к реализации проекта «Бережливый вуз». Результаты. Опрошено 1508 студентов. По результатам исследования основными движущими силами, мотивирующими студентов к проектной деятельности, являются: в группе имеющих опыт реализации проектов-желание решить проблему, которая влияет на обучающихся (60%), для студентов без опыта участия в реализации проектов-желание получить новый опыт, знания и навыки (40%). Желание принести пользу вузу оказалось на втором месте по значимости для обеих групп респондентов (57 и 36% соответственно). Факторами, препятствующим началу проектной деятельности, с точки зрения студентов являются: отсутствие свободного времени (более 60 респондентов в каждой из групп), недостаточное понимание того, что собой представляет работа по проекту (более 30% в каждой группе), ошибочное убеждение, суть которого состоит в том, что над проектом невозможно работать удаленно (не посещая/редко посещая проектный офис) (19% опрошенных в группе, не принимавших участие в работе над проектами). Заключение. Сформулированы рекомендации, позволяющие за счет активизации студенческой среды формировать практические навыки применения бережливых техно-4.0 Т. В. Гайворонская, Л. В. Верменникова, Е. А. Чабанец, А. А. Рыкова. Применение анализа поля сил и модели организационных изменений К. Левина для повышения...

Section: Introductionunclassified

Force Field Analysis and K. Lewin’s Change Model as leverages of “Lean University” principles in student environment

Gaivoronskaya

Верменникова

Chabanets

et al. 2021

Analysis of Value Dimensions in Public Satisfaction with Primary Health Care: Prospective Observational Study

Мазунина

Петров

Melkonyan

et al. 2023

Background. Artificial neural network models can be used to analyze and predict structural components within the value dimension of the main processes in an outpatient clinic as indicators of patient satisfaction.Objective — to form and test the methodology for analyzing and predicting structural components within the value dimension of the main processes in an outpatient clinic, as indicators of patient satisfaction with availability and quality of medical care, using artificial intelligence.Methods. The results of questionnaires administered to 525 patients were used to analyze their satisfaction with GP appointments. A network ensemble consisting of radial basis network and multilayer perceptron was chosen as the basis for a neural network model. The model testing involved five outpatient clinics in Kirov. The total number of respondents comprised 217 patients. Statistical processing included data description and analysis. Qualitative attributes were represented by relative values (P, %). The statistical significance of differences in qualitative data was assessed using the Chi-square test. The correlation between the observed and predicted data was assessed by means of nonparametric Spearman correlation analysis. The value of p <0.05 was chosen as the significance level ( p). Statistical data processing was performed using Statistica 13.0.Results. Analysis of the value dimensions of satisfaction showed a predominance of “pre-appointment” stage: work of a registrar (85.29% significance in the receiving medical services), waiting time for an appointment with a doctor (66.76% respondents noted its significance), duration of waiting directly at the office (important for 69.11% of respondents). “Appointment” stage was formed according to the common procedure of a GP appointment (interview, examination, recommendations) and was assessed from the value perspective of the patient. The priority components included sufficiency of appointment duration (significant in 88.27% of cases), satisfaction with examination (significant in 85.14% of cases), as well as completeness and informativeness of consultation (significant in 89.9% of cases). A strong direct correlation between the observed and predicted data (ρxy = 0.9; p < 0.05) was found out. Statistically significant differences between the observed and predicted levels of general patient satisfaction were not revealed in all medical organizations.Conclusion. The suggested neural network models can be used as the basis when creating information management systems that monitor meeting the effectiveness criteria for a new model of a medical organization; as well as an essential support for administrative decisions related to organizing the optimal patient management.

Experience of strategic sessions to improve the quality of lean technology implementation in medical organizations in Krasnodar Krai: a one-stage observational study

Alekseenko,

Filippov,

Kagramanyan

et al. 2024

Background. Lean production is mainly focused on increasing value in processes and improving the quality of services provided. These principles are implemented in medical organizations within the framework of the national project “Healthcare” and the federal project “Development of the Primary Healthcare System”. Introduction of lean technologies at all levels of the organization can serve as a highly effective method of positive changes. In 2023, Kuban State Medical University, together with the Ministry of Health of Krasnodar Krai and the Regional Center for Primary Healthcare, held a strategic session aimed at identifying problematic processes in medical organizations of the region and jointly searching for ways to solve them. The session involved 73 primary healthcare organizations. Its results formed the basis for a study of the project activity of medical organizations. Objective. To analyze the current state of project activities of medical organizations in Krasnodar Krai to achieve a “new model” through the introduction of lean technologies.Methods. A one-stage observational study was carried out in two steps. The first step involved participant observation. Its results determined a set of tools to be compiled. The second step of the study included a questionnaire survey and analysis of information. The data obtained from the questionnaire survey and observation were coded, the distribution and frequency were identified using frequency analysis and calculation of mean values. The qualitative analysis of open-ended questions was additionally applied.Results. The analysis showed that the prevailing number of projects are aimed at forming and developing the availability of medical care for the population (50.6 %), including projects focused on inclusiveness and provision of medical care to low-mobility patients at home. It was also revealed that 42 projects in four areas are planned for implementation in 47 organizations using lean technology tools in 2024. The study showed that 91.49 % of projects failed to calculate financial efficiency and evaluate project results in monetary terms. Meanwhile, 8.51 % of those who carried out the efficiency calculations lacked an analysis methodology and revealed the superficiality of the calculations. Of all the participants, 53.19 % reported the need for help in organizing and implementing project activities, and 36.17 % of the participants had enough resources to cope on their own. The three most problematic processes requiring joint work with colleagues included “Reducing the wait times for healthcare in regional medical organizations,” “Registration of discounted prescriptions” and “Preventive medical examination and dispensary.”Conclusion. The experience of a strategic session at Kuban State Medical University proved to be effective in improving the quality of implementation of lean technologies in medical organizations of Krasnodar Krai. The study was instrumental in assessing the current state of the project activities of medical organizations to achieve a “new model” through the introduction of lean technologies, as well as in identifying the most common areas of project activities and the main problems. The performed analysis revealed a positive trend in improving the quality of work of medical organizations in Krasnodar Krai and disseminating the lean technologies in primary healthcare.